The Impact of Social Determinants of Health on the Diagnosis of Type 2 Diabetes Mellitus (T2DM) Among Asian Indians (AIs) in New Jersey: A Secondary Analysis of the BRFSS Survey From 2013 to 2017

INTRODUCTION

Asian Indians (AIs), the second largest immigrant population in the United States, are disproportionately affected by type 2 diabetes mellitus (T2DM) at a lower age and body mass index (BMI). The purpose of this study was to examine the relationship between social determinants of health (SDOH) and the diagnosis of T2DM among AIs in New Jersey (NJ).

METHODOLOGY

This was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) in NJ from 2013 to 2017. Statistical analyses included descriptive and inferential statistics.

RESULTS

Among 1,132 AIs, 16% had T2DM or prediabetes (PDM) and 69.2% were overweight or obese. The risk for T2DM was significantly associated with internet use, older age, having medical check-ups, and having a personal doctor (p ≤ .05).

DISCUSSION

These findings inform culturally congruent care by underscoring the importance of weight management, earlier screening, and provider involvement in diabetes prevention strategies for AIs.

Mothers' perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds

HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers' hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.

Parents' Intentions, Concerns and Information Needs about COVID-19 Vaccination in New Jersey: A Qualitative Analysis

BACKGROUND

In 2019, the World Health Organization identified vaccine hesitancy as a top ten global health threat, which has been exacerbated by the COVID-19 pandemic. Despite local and nationwide public health efforts, adolescent COVID-19 vaccination uptake in the US remains low. This study explored parents' perceptions of the COVID-19 vaccine and factors influencing hesitancy to inform future outreach and education campaigns.

METHODS

We conducted two rounds of individual interviews via Zoom in May-September 2021 and January-February 2022, with parents of adolescents from the Greater Newark Area of New Jersey, a densely populated area with historically marginalized groups that had low COVID-19 vaccination uptake. Data collection and analysis was guided by the Increasing Vaccination Model and WHO Vaccine Hesitancy Matrix. Interview transcripts were double-coded and thematically analyzed in NVivo.

RESULTS

We interviewed 22 parents (17 in English, 5 in Spanish). Nearly half (45%) were Black and 41% were Hispanic. Over half (54%) were born outside of the US. Most of the parents described that their adolescents had received at least one dose of a COVID-19 vaccine. All but one parent had received the COVID-19 vaccine. Despite strong vaccination acceptance for themselves, parents remained hesitant about vaccinating their adolescents. They were mostly concerned about the safety and potential side effects due to the novelty of the vaccine. Parents sought information about the vaccines online, through healthcare providers and authorities, and at community spaces. Interpersonal communication exposed parents to misinformation, though some personal connections to severe COVID-19 illness motivated vaccination. Historical mistreatment by the healthcare system and politicization of the vaccine contributed to parents' mixed feelings about the trustworthiness of those involved with developing, promoting, and distributing COVID-19 vaccines.

CONCLUSIONS

We identified multilevel influences on COVID-19 vaccine-specific hesitancy among a racially/ethnically diverse sample of parents with adolescents that can inform future vaccination interventions. To increase vaccine confidence, future COVID booster campaigns and other vaccination efforts should disseminate information through trusted healthcare providers in clinical and also utilize community settings by addressing specific safety concerns and promoting vaccine effectiveness.

Cervical Cancer Screening Among Older Garifuna Women Residing in New York City

This study examined the level of adherence to the recommended cervical cancer screening guidelines among Garifuna women residing in New York City, and screening practice association with demographic factors, access to healthcare services, perceptions/barriers to cervical cancer screening, acculturation, identity, and level of screening guideline knowledge. Four hundred Garifuna women were surveyed. The study results reveal low self-reported cervical cancer screening rates (60%), increased age, visiting a Garifuna healer in the past year, perceived benefits of receiving the screening test, and knowledge of the Pap test as having the highest predictive variability for receiving cervical cancer screening. The odds of having a Pap test were significantly lower in older women (age 65 years and above) and those visiting a traditional healer within the past year. The study findings provide several implications for developing culturally appropriate interventions aimed to increase the level of cervical cancer screening in this unique immigrant group.

Factors that Influence Healthcare Provider Recommendation of HPV Vaccination

Purpose: This study examined factors associated with healthcare providers' (HCPs') recommendation of HPV vaccination for younger and older adolescents. Methods: This is a cross-sectional study, using web-based survey of HCPs in New Jersey in 2018. The study outcome was a dichotomous measure of HCPs' recommendation of the HPV vaccine. The study predictors included practice characteristics (i.e., proportions of race/ethnicity, age groups, insurance type, and VFC recipients) and HCP's characteristics (i.e., specialty and perceived knowledge, effectiveness, concerns, parent- and system-related barriers, and facilitators). Data analysis included logistic regression models using separate blocks for practice and provider characteristics, followed by a backward stepwise approach to determine the surviving predictors. Results: Respondents (N=390) included physicians (75%) and nurse practitioners (25%), specialized in pediatrics (62%), family medicine (20%), and women's health (18%). The HCPs' recommendation rates for HPV vaccination were 56% for younger adolescents (11-13 years old) and 73% for older adolescents (14-17 years old). For younger adolescents, the recommendation rates were significantly higher in practices with higher proportions of younger adolescent, Black and Hispanic patients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine. For older adolescents, the rates were significantly higher in practices with higher proportions patients who are Hispanic, privately insured, and VFC recipients; among pediatric providers; and with HCPs' higher levels of knowledge and lower levels of concern about the vaccine as well as higher levels of facilitators for recommending the HPV vaccine. Conclusions: Interventions targeting HCPs need to focus on improving their knowledge regarding the vaccine, reduce their concerns around its safety, and utilize facilitators strategies, particularly among non-pediatric providers.

Understanding primary care physician perspectives on recommending HPV vaccination and addressing vaccine hesitancy

HPV vaccination rates have improved in recent years, but remain suboptimal in the United States. Physician recommendation is associated with increased uptake; however, specific strategies used by physicians to recommend the vaccine and address hesitancy are underexplored. We iteratively conducted qualitative in-depth interviews with family medicine and pediatrics/adolescent medicine physicians recruited from four primary care settings (federally qualified health centers and hospital-affiliated practices) within a large academic-hospital system in New Jersey. Interviews aimed to understand factors influencing physician recommendations. Transcripts were analyzed iteratively using a team-based, thematic content analysis approach. All physicians reported strong support for HPV vaccination, intention to recommend for target age groups, and providing factsheets to parents. Many physicians used electronic medical records and/or the state immunization registry for monitoring vaccinations, but few were able to report their own clinic-level rates. The majority said they needed to overcome both hesitancy for at least 10-30% of parents and misinformation from the internet. Most cited having their own children vaccinated for HPV as a first-line strategy for addressing parental hesitancy. Other strategies included using data or professional authority to address safety concerns, linking HPV to cervical cancer, highlighting only needing two doses if vaccinated younger, and normalizing the vaccine. While our findings indicate physicians are knowledgeable about HPV vaccination and recommend it to parents, strategies to overcome parental hesitancy varied. Physician, clinic, and health-system-based strategies need to be adopted to overcome parental hesitancy for HPV vaccination.

Knowledge and Attitudes Toward Human Papillomavirus Vaccination Among Latina Mothers of South American and Caribbean Descent in the Eastern US

Purpose: The purpose of this study was to examine knowledge, attitudes, barriers, and facilitators for human papillomavirus (HPV) vaccination among Latina mothers of HPV vaccine-eligible children in low-income urban areas, as well as useful strategies to improve HPV vaccination. Methods: The study included 132 Latina mothers of HPV vaccine-eligible children, interviewed in 14 focus groups. Using semi-structured discussions, mothers were asked about their knowledge about HPV infection and vaccine, views toward HPV vaccination, barriers for HPV vaccine initiation as well as completion, and opinions on strategies to improve HPV vaccination. Results: Only 55% of mothers reported having ever heard of the HPV vaccine, 27% of mothers indicated initiating the HPV vaccine, and 14% indicated completing the multi-dose series. Mothers generally lacked knowledge about HPV infection and vaccination, with varying degrees by Latino descent. Health care provider (HCP) recommendation was the strongest barrier/facilitator for HPV vaccination. Useful strategies to improve HPV vaccine initiation and completion that the mothers suggested included strong recommendation from HCPs and addressing side effects and safety concerns. Other useful strategies included community and school-based approaches and the use of text messaging and smartphone technology to educate mothers and send vaccine reminders. Conclusion: The findings provide insight for the development of interventions targeting low-income Latina mothers and the need to improve HCP communication on HPV vaccination.

History of Childhood Abuse and Risk for Cervical Cancer Among Women in Low-Income Areas

PURPOSE

The purpose of this study was to examine pathways through which childhood abuse increases the risk of cervical cancer, including smoking, stress, risky sexual behavior, and not having a Papanicolaou (Pap) test.

MATERIALS AND METHODS

This is a descriptive, correlational study. The sample included 410 women, recruited from a large, multisite women's health center that serves low-income communities in New Jersey. Data were analyzed using path models and conditional regression analysis.

RESULTS

Overall, 15% and 12% of the women in the study reported history of physical and sexual childhood abuse, respectively. There was a significant association between child abuse history and failure to receive a Pap test (χ² = 5.34, p = 0.021). History of childhood abuse was associated with 44% lower odds of having a Pap test. The findings indicate a significant association between child abuse history and cervical cancer risk (χ² = 7.65, p = 0.006, Cramer's V = 0.138). History of childhood abuse was associated with 96% higher odds of being at risk of cervical cancer. Both physical and sexual abuses were associated with higher levels of smoking, risky sexual behavior, perceived stress, and cervical cancer risk. In the conditional regression analysis, the effect of risky sexual behavior on the likelihood of cervical cancer risk showed an increased risk with higher risky sexual behavior scores only for those with a history of childhood abuse.

CONCLUSION

Childhood abuse increases the risk of cervical cancer in adulthood, through failure to receive a Pap test and higher levels of smoking, perceived stress, and most importantly, risky sexual behavior. More importantly, the combination of childhood abuse and risky sexual behavior plays a greater role in increasing cervical cancer risk.

Attitudes of Palestinians Toward Social Work Interventions in Cases of Wife Assault

The study examined the attitudes of Palestinian adults toward social work interventions in cases of husband-to-wife assault (HWA). A survey, using self-administered questionnaires and interviews, was conducted among a random sample of 624 adults from the Palestinian Authority. Results indicate higher levels of support for interventions aimed at helping the couple solve their problems than for interventions aimed at protecting the safety of battered women. However, this trend becomes reversed in cases of repeated and severe HWA. Greater support for interventions aimed at protecting the safety of battered women was found among women versus men and younger versus older adults, as well as among individuals with lower levels of justifying wife abuse and more egalitarian expectations of marriage.

Ethical conduct in intimate partner violence research: challenges and strategies

Intimate partner violence (IPV) research has expanded dramatically in the past 2 decades. However, updated ethical guidelines to protect the safety and autonomy of research participants, study data, and the research team are still lacking in this evolving area of research. This article presents general concepts in research ethics and the specific challenges and strategies for IPV research related to recruitment and retention, maintenance of women's safety, privacy, and confidentiality, and their voluntary participation as well as assessment of benefits and risks, strategies to minimize risk, the Certificates of Confidentiality, and training of the research team. This area of nursing research is critical for developing practice guidelines and improving the health and quality of life of abused women.

Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

BACKGROUND

Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory.

METHODS

A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15-64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husband's direct exposure, his indirect exposure via his family's experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence.

FINDINGS

Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1.89 (95% CI 1.29-2.76) for physical and 2.23 (1.49-3.35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1.61 (1.25-2.07) for physical and 1.97 (1.49-2-60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only.

INTERPRETATION

Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings.

Care provided in visits coded for intimate partner violence in a national survey of emergency departments

PURPOSE

This article describes the health status of and care provided to patients in visits coded to intimate partner violence (IPV) victims in a national survey of emergency departments (EDs). Visits coded for IPV were defined by International Classification of Diseases, 8th edition-Clinical Modification (ICD-9-CM) codes.

METHODS

Data from the National Hospital Ambulatory Medical Care Survey for 1997-2001 were analyzed. The sample consisted of 111 ED visits with ICD codes for IPV (or 12 IPV visits per 10,000 ED visits, and 21 female IPV visits per 10,000 female ED visits).

FINDINGS

The majority of visits coded to IPV were for patients who presented with mild to moderate pain (86%), physical or sexual violence (50%), and injuries to the body (38%). The majority of patients in visits coded to IPV received radiologic testing, wound care, and pain medications (odds ratios [ORs], 1.6, 3.3, and 2.3 respectively). Disposition was mostly referral to another physician or clinic (42%) or return to the ED when needed (20%), but much less to nonphysician services such as social services, support services, and shelters (14%). Uninsured IPV patients were more likely to receive radiologic testing and pain medications (ORs 5.1 and 3, respectively). Patients seen by nurses were 9 times more likely to receive wound care.

CONCLUSION

Caution should be exercised when interpreting the study results because they reflect only coded IPV visits in the ED and these might be the most obvious IPV cases. The results signal the need for further studies to evaluate access to and the quality of care for IPV patients and to improve screening, documentation, coding, and management practices.

Attitudes of Jordanian society toward wife abuse

The authors conducted an exploratory study among a convenience sample of 260 Jordanian men and women, using self-administered open and closed questions to examine the participants' approach toward wife abuse. In general, there was high awareness of wife abuse and the different types of abuse (mainly physical and psychological), a general tendency to oppose wife abuse, a tendency to blame the victim for abuse, and a lesser tendency to blame the abuse on the husband, marital problems, as well as familial and societal conditions. There was also a strong tendency to consider wife abuse a personal and familial issue rather than a social and legal problem. Therefore, the preferred method for coping with wife abuse and violence was the expectation that the abused wife should change her behavior and assume responsibility to change her husband followed by resorting to informal agents (family or community or religious figures). Less preferred coping methods included confronting the husband and expressing desire to break up or separate and resorting to formal agents (social welfare programs, counseling, legal system), as a last resort in cases of repeated abuse and severe physical violence. The implications of these findings for future research, interventions, and policy formulation are discussed.

Visits coded as intimate partner violence in emergency departments: characteristics of the individuals and the system as reported in a national survey of emergency departments

INTRODUCTION

This study was conducted to explore the characteristics of intimate partner violence (IPV) victims whose visit was coded as IPV and the health care delivery system in emergency departments (ED).

METHODS

This study utilized a secondary data analysis of a national probability sample that comprised the National Hospital Ambulatory Medical Care Survey for 1997 to 2001.

RESULTS

There were 111 coded ED visits of IPV victims 16 years or older (equivalent of 482,979 out of 4 million national visits for the 5-year study period). Women (94%), African Americans (35%), those 25 to 44 years of age (64%), and uninsured patients (38%) were significantly more likely to be categorized as an IPV visit (odds ratios 14, 1.9, 2.7, and 2.4, respectively) compared with non-IPV visits. Characteristics of the health care delivery system (region, metropolitan vs. non-metropolitan, type of hospital, and type of health care provider) were not associated with IPV.

DISCUSSION

Caution should be implemented when interpreting the study results because they represent only coded IPV visits in the emergency department. The study findings suggest the critical need to improve identification, documentation, and coding of IPV visits.

A history of public health workforce enumeration

During the 20th century, the United States' public health workforce has been of sufficient interest to policy makers that regular efforts have been made to enumerate it. Limited enumeration is found as early as 1908; the last direct federal survey occurred in 1964. After 1964, workforce size was estimated. The ratio of public health workers to population reached an estimated 220/100,000 in 1980. Data collected in 2000 yielded a ratio of 158/100,000--a 10 percent decrease. In the absence of a system to reliably collect public health workforce data such information is problematic to interpret or use for infrastructure planning and development.

Identifying individual competency in emerging areas of practice: an applied approach

Competency designation is important for any discipline to define individual performance expectations. Although public health (PH) agencies have always responded to emergencies, individual expectations have not been specified. The authors identified individual competencies necessary for organizations to meet performance standards. In the first stage, a Delphi survey served to identify competencies needed by staff to respond to any emergency, including bio-terrorism, yielding competency sets for four levels of workers. In the second stage, focus groups were used to assess the competencies with public health agencies. This feedback validated the Delphi-identified competencies as accurate and necessary for emergency response. The authors demonstrate the feasibility of using these methods to arrive at statements of value to PH practice at a reasonable investment of resources.